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. 2001 Aug;11(3):207–218. doi: 10.1055/s-2001-16609

Carotid-Cavernous Fistulas

Pathogenesis and Routes of Approach to Endovascular Treatment

Harish Shownkeen, Davide Bova, Thomas C Origitano, Guy J Petruzzelli, John P Leonetti
PMCID: PMC1656855  PMID: 17167622

Abstract

The etiology, classification, clinical presentation, complications, and intravascular routes to image and treat carotid-cavernous fistulas percutaneously are described. Endoarterial and transvenous approaches (through the jugular, inferior petrosal, or cavernous veins) are discussed in relation to the etiology, size, and characteristics of the fistulas, as well as in relation to the planned therapeutic approach and its possible complications. Possible outcomes, with particular attention to the internal carotid circulation, side effects, and complications also are discussed in relation to etiology and type of fistula. Four exemplary cases are presented.

Keywords: Carotid-cavernous sinus fistula, cerebral angiography, therapeutic embolization, balloon occlusion

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Selected References

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  1. Barrow D. L., Spector R. H., Braun I. F., Landman J. A., Tindall S. C., Tindall G. T. Classification and treatment of spontaneous carotid-cavernous sinus fistulas. J Neurosurg. 1985 Feb;62(2):248–256. doi: 10.3171/jns.1985.62.2.0248. [DOI] [PubMed] [Google Scholar]
  2. Beylot C., Bioulac P., Doutre M. S. Les manifestations artérielles du syndrome d'Ehlers-Danlos. Ann Med Interne (Paris) 1983;134(5):451–457. [PubMed] [Google Scholar]
  3. Courtheoux P., Labbe D., Hamel C., Lecoq P. J., Jahara M., Théron J. Treatment of bilateral spontaneous dural carotid-cavernous fistulas by coils and sclerotherapy. Case report. J Neurosurg. 1987 Mar;66(3):468–470. doi: 10.3171/jns.1987.66.3.0468. [DOI] [PubMed] [Google Scholar]
  4. Debrun G., Lacour P., Vinuela F., Fox A., Drake C. G., Caron J. P. Treatment of 54 traumatic carotid-cavernous fistulas. J Neurosurg. 1981 Nov;55(5):678–692. doi: 10.3171/jns.1981.55.5.0678. [DOI] [PubMed] [Google Scholar]
  5. Grove A. S., Jr The dural shunt syndrome. Pathophysiology and clinical course. Ophthalmology. 1984 Jan;91(1):31–44. doi: 10.1016/s0161-6420(84)34330-5. [DOI] [PubMed] [Google Scholar]
  6. Guglielmi G., Viñuela F., Briganti F., Duckwiler G. Carotid-cavernous fistula caused by a ruptured intracavernous aneurysm: endovascular treatment by electrothrombosis with detachable coils. Neurosurgery. 1992 Sep;31(3):591–597. doi: 10.1227/00006123-199209000-00026. [DOI] [PubMed] [Google Scholar]
  7. Halbach V. V., Higashida R. T., Hieshima G. B., Hardin C. W., Yang P. J. Transvenous embolization of direct carotid cavernous fistulas. AJNR Am J Neuroradiol. 1988 Jul-Aug;9(4):741–747. [PMC free article] [PubMed] [Google Scholar]
  8. Hirai T., Korogi Y., Baba Y., Nishimura R., Hamatake S., Kawanaka K., Bussaka H., Takahashi M. Dural carotid cavernous fistulas: role of conventional radiation therapy--long-term results with irradiation, embolization, or both. Radiology. 1998 May;207(2):423–430. doi: 10.1148/radiology.207.2.9577491. [DOI] [PubMed] [Google Scholar]
  9. Katsiotis P., Kiriakopoulos C., Taptas J. Carotid-cavernous sinus fistulae and dural arteriovenous shunts. Vasc Surg. 1974 Jan-Feb;8(1):60–69. [PubMed] [Google Scholar]
  10. Keltner J. L., Satterfield D., Dublin A. B., Lee B. C. Dural and carotid cavernous sinus fistulas. Diagnosis, management, and complications. Ophthalmology. 1987 Dec;94(12):1585–1600. doi: 10.1016/s0161-6420(87)33258-0. [DOI] [PubMed] [Google Scholar]
  11. Keltner J. L., Satterfield D., Dublin A. B., Lee B. C. Dural and carotid cavernous sinus fistulas. Diagnosis, management, and complications. Ophthalmology. 1987 Dec;94(12):1585–1600. doi: 10.1016/s0161-6420(87)33258-0. [DOI] [PubMed] [Google Scholar]
  12. Lewis A. I., Tomsick T. A., Tew J. M., Jr, Lawless M. A. Long-term results in direct carotid-cavernous fistulas after treatment with detachable balloons. J Neurosurg. 1996 Mar;84(3):400–404. doi: 10.3171/jns.1996.84.3.0400. [DOI] [PubMed] [Google Scholar]
  13. Manelfe C., Berenstein A. Traitement des fistules carotido-caverneuses par voie veineuse. A propos d'un cas. J Neuroradiol. 1980;7(1):13–19. [PubMed] [Google Scholar]
  14. Norman D., Newton T. H., Edwards M. S., DeCaprio V. Carotid-cavernous fistula: closure with detachable silicone balloons. Radiology. 1983 Oct;149(1):149–157. doi: 10.1148/radiology.149.1.6611922. [DOI] [PubMed] [Google Scholar]
  15. Spinelli H. M., Falcone S., Lee G. Orbital venous approach to the cavernous sinus: an analysis of the facial and orbital venous system. Ann Plast Surg. 1994 Oct;33(4):377–384. doi: 10.1097/00000637-199410000-00004. [DOI] [PubMed] [Google Scholar]
  16. Teng M. M., Guo W. Y., Lee L. S., Chang T. Direct puncture of the cavernous sinus for obliteration of a recurrent carotid-cavernous fistula. Neurosurgery. 1988 Jul;23(1):104–107. doi: 10.1227/00006123-198807000-00019. [DOI] [PubMed] [Google Scholar]
  17. Teng M. M., Lirng J. F., Chang T., Chen S. S., Guo W. Y., Cheng C. C., Shen W. C., Lee L. S. Embolization of carotid cavernous fistula by means of direct puncture through the superior orbital fissure. Radiology. 1995 Mar;194(3):705–711. doi: 10.1148/radiology.194.3.7862966. [DOI] [PubMed] [Google Scholar]
  18. Viñuela F., Fox A. J., Debrun G. M., Peerless S. J., Drake C. G. Spontaneous carotid-cavernous fistulas: clinical, radiological, and therapeutic considerations. Experience with 20 cases. J Neurosurg. 1984 May;60(5):976–984. doi: 10.3171/jns.1984.60.5.0976. [DOI] [PubMed] [Google Scholar]
  19. WEISS D. I., SHAFFER R. N., NEHRENBERG T. R. Neovascular gluacoma complicating carotid-cavernous fistula. Arch Ophthalmol. 1963 Mar;69:304–307. doi: 10.1001/archopht.1963.00960040310007. [DOI] [PubMed] [Google Scholar]

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